Provider Demographics
NPI:1306462239
Name:KUELBS, ANDREW THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:THOMAS
Last Name:KUELBS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 COASTAL GRASS WAY UNIT 108
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-9256
Mailing Address - Country:US
Mailing Address - Phone:763-291-8025
Mailing Address - Fax:
Practice Address - Street 1:216 MYERS RD STE A
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-8819
Practice Address - Country:US
Practice Address - Phone:843-261-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC96521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice